Claims Customer Service Representative
$39,520–$47,840 year
On-siteFresno, California, United States
Job Summary
Respond to Provider inquiries regarding medical and dental claims via phone and email. Research and resolve issues related to claims status, denials, and payment discrepancies. Maintain up-to-date knowledge of benefit plans, claim adjudication guidelines, coding requirements, and HIPAA regulations. Accurately document all interactions and claim actions in the Company system by compliance standards. Communicate complex benefit details in a clear and concise manner to Providers. Collaborate with internal departments to facilitate resolution of claims-related issues. Recommend process improvements to enhance service delivery and improve Provider experience. Ensure all duties are completed with a focus on quality, compliance, and Provider satisfaction.
Required Qualifications
- Minimum of two (2) years work experience
- Ability to access all areas of the center throughout the workday
- Ability to lift a minimum of 35 pounds occasionally, 15 pounds frequently, and 7 pounds constantly
- Ability to communicate verbally with an excellent comprehension of the English language
- At a minimum a High School Diploma or GED
Desired Qualifications
- knowledge of claims processing software
- Familiarity with medical billing terminology (ICD-10, CPT, HCPCS) and Explanation of Payments (EOPs)
- Minimum of one (1) year of experience working in a healthcare call center
- Experience working remotely
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